Waking up to chronic care

We are currently experiencing in the United Kingdom something of a backlash against the recent assertions1 that the National Health Service (NHS) has something to learn from the large Health Maintenance Organizations in the United States such as Kaiser.2 Whatever the arguments about the relevance of comparisons between our systems, the Chronic Care Model (CCM)3 is a transatlantic development that really does deserve our close attention because it is an intelligent and pragmatic approach to restructuring care systems. More than “disease management”, it offers a common technology that can be applied across several different chronic conditions. The central role played by the care manager in measuring progress and outcome of care, ensuring follow up, and enabling the “stepping up” or “stepping down” of the intensity of care provided when required according to data systematically collected is a revolutionary concept to many health professionals. This is because the model of chronic illness care in which they were trained and still deliver is actually acute care—managing …